本文選題：手足口病 + 流行病學(xué)��； 參考：《山東大學(xué)》2012年碩士論文

【摘要】：[研究背景] 手足口病是一種由腸道病毒引起的急性病毒性傳染病。我國是手足口病的高發(fā)國家,白1981年在上海發(fā)現(xiàn)首例手足口病患者后,全國十多個省(市)相繼出現(xiàn)手足口病流行。到目前為止,全國各省、自治區(qū)、直轄市均有手足口病病例報告。近年來,我國部分地區(qū)陸續(xù)出現(xiàn)了手足口病的大規(guī)模暴發(fā)流行,尤以廣州、安徽、山東、河南、江蘇等省份疫情最為嚴重。全國手足口發(fā)病和死亡人數(shù)也呈逐年上升趨勢,2010年我國大陸地區(qū)共報告手足口病病例177.35萬,較2009年的115.38萬例病例同比增長53.71%,其中2010年死亡904人,死亡病例數(shù)與2009年相比增長了155.37%。手足口病對兒童青少年的健康已構(gòu)成嚴重危害,加強手足口病的規(guī)范化預(yù)防控制刻不容緩。 [研究目的] 1.分析2007～2011年山東省手足口病的流行特征、人群發(fā)病特征、時間分布特征,為手足口的防控提供科學(xué)依據(jù)。 2.分析山東省手足口病的病原學(xué)構(gòu)成特征。 3.建立新型腸道病毒71型(enterovirus71, EV71)山東地方株VP1編碼區(qū)全基因序列數(shù)據(jù)庫,分析EV71山東地方株基因進化特征。 4.建立柯薩奇病毒A組16型(coxsackievirus A16, CoxA16)山東地方株VPl編碼區(qū)全基因序列數(shù)據(jù)庫,分析CoxA16山東地方株基因進化特征。 5.分析手足口病死亡病例的臨床特征及死亡危險因素。 [研究方法] 1.描述性研究：根據(jù)中國疾病預(yù)防控制信息系統(tǒng)手足口病發(fā)病報告信息,統(tǒng)計分析2007-2011年山東省手足口病發(fā)病率、年齡別構(gòu)成比、性別構(gòu)成比、病原學(xué)構(gòu)成比等描述性指標(biāo),應(yīng)用流行病學(xué)原理描述山東省手足口病的三間分布特征。根據(jù)手足口病個案調(diào)查結(jié)果,對手足口病死亡病例的臨床特征進行描述分析。 2.病原學(xué)特征研究：隨機抽取各地市送檢手足口病患者糞便、咽拭子標(biāo)本,經(jīng)病毒分離、核酸提取、RT-PCR、序列測定等步驟,分析2007～2011年山東省手足口病病原EV71和CoxA16的基因進化特征。 3.死亡危險因素分析：以手足口病死亡病例為病例組,重癥病例為對照組,采用1：3匹配的病例對照研究分析手足口病的死亡危險因素。研究采用條件Logistic回歸對變量進行分析,應(yīng)用SAS9.1軟件進行統(tǒng)計分析。 [研究結(jié)果] 1.2007～2011年山東省各年手足口病總發(fā)病人數(shù)分別為38267例、32434例、138227例、141744例、95796例,累積發(fā)病率分別為4.09/萬、3.46/萬、14.76/萬、15.13/萬和10.01/萬。 2.山東省手足口病患者以5歲以下兒童為主。2007～2011年,5歲以下病例占當(dāng)年總病例數(shù)的比例分別為88.57%、91.28%、91.89%、91.21%、89.00%。重癥病例多集中于3歲以下年齡組。2009～2011年,3歲以下重癥病例占當(dāng)年重癥病例總數(shù)的比例分別為84.08%、77.94%、73.01%。手足口病病例男性多于女性,2007-2011年手足口病病例男女性別比波動在1.66-1.80之間；5-8月是手足口病高發(fā)期,2007-2011年中,各年5-8月手足口病發(fā)病人數(shù)占當(dāng)年總發(fā)病人數(shù)的比例分別為81.38%、77.73%、64.10%、74.72%、73.60%。 3.EV71和CoxA16是引起山東省手足口病暴發(fā)流行的主要病原體。2008～2011年各年EV71所致手足口病病例數(shù)占當(dāng)年總病例數(shù)的比例分別為60.53%、67.02%、34.69%、50.57%；2008～2011年各年CoxA16所致手足口病病例數(shù)占當(dāng)年總病例數(shù)的比例分別為27.63%、3.64%、37.08%、29.78%。 4.2007～2011年67株EV71山東地方株均為EV71C4a亞型。2011年EV71山東地方株與CoxA16原型株之間的核苷酸同源性為62.1%-63.4%,與EV71原型株之間的核苷酸同源性為80.5%～82.9%,與EV71B型代表株之間的核苷酸同源性為83.0%～85.4%,與EV71C1代表株之間的核苷酸同源性為85.6%-88.5%,與EV71C2代表株之間的核苷酸同源性為87.4%～90.3%,與EV71C3代表株之間的核苷酸同源性為86.7%～88.7%,與EV71C4a代表株之間的核苷酸同源性為93.3%～96.6%,與EV71C4b代表株之間的核苷酸同源性為90.1%～93.1%。 5.2007～2011年38株CoxA16山東地方株全屬于B1亞型。2011年CoxA16山東地方株與CoxA16原型株之間的核苷酸同源性為75.1%～77.3%,與B2原型株之間的核苷酸同源性為89.0%～９0.0%,與2007年7株山東地方株之間的核苷酸同源性為90.9%-95.3%。 6.死亡病例總病程平均時間為82.40±5.39小時,發(fā)熱最高體溫平均值為39.08±0.15℃�？人�(OR=16.16，P=0.0398)、頸抵抗(OR=189.50,P=0.0072)、嘔吐(OR=16.16,P=0.0398)是手足口病重癥病例死亡的危險因素,年齡增加(OR=8.04,P=0.0131)是病例死亡的保護因素。 [結(jié)論與建議] 1.山東省手足口病發(fā)病率高,重癥發(fā)生率高,危害嚴重,應(yīng)加強防控。 2.5歲以下兒童為手足口病高發(fā)人群,其中3歲以下兒童是手足口病重癥及死亡的高危人群,應(yīng)加強對3歲以下手足口病患兒的臨床監(jiān)護,防治患兒發(fā)生重癥或死亡。 3.5～8月是手足口病的高發(fā)時期,衛(wèi)生部門應(yīng)在該時間內(nèi)加強對兒童青少年的衛(wèi)生宣傳教育,做好托幼機構(gòu)、小學(xué)等兒童聚集地的消毒,防止手足口病暴發(fā)流行。 4.EV71是山東省手足口病的最主要優(yōu)勢病原體,EV71感染是重癥發(fā)生的危險因素。 5.EV71和CoxA16處于不斷地基因突變過程當(dāng)中且病毒變異速度較快,應(yīng)加強對EV71和CoxA16流行的監(jiān)測,防止新型毒株的出現(xiàn)并造成流行。 6.咳嗽、頸抵抗、嘔吐是手足口病病例死亡的危險因素,年齡增加是病例死亡的保護因素。應(yīng)加強出現(xiàn)咳嗽、頸抵抗、嘔吐癥狀的低齡手足口病重癥患兒的臨床監(jiān)護,防止死亡發(fā)生。
[Abstract]:[research background]
Foot and mouth disease is an acute infectious disease caused by enterovirus. China is a country with high incidence of HFMD in 1981, found that patients with first hand foot and mouth disease in Shanghai, the country's more than 10 provinces (city) have HFMD epidemic. So far, the provinces, autonomous regions, have foot and mouth disease case report of municipalities directly under the central government. In recent years, some regions of China emerged HFMD pandemic, especially in Guangzhou, Anhui, Shandong, Henan, Jiangsu and other provinces. The most serious outbreak of HFMD cases and deaths also increased year by year, in 2010, China reported a total 1 million 773 thousand and 500 HFMD cases were 1 million 153 thousand and 800 cases, an increase of 53.71% in 2009 2010, which killed 904 people, the number of deaths compared with 2009 growth of healthy 155.37%. HFMD on children and adolescents has posed a serious hazard, It is urgent to strengthen the standardized prevention and control of hand foot and foot disease.
[research purposes]
1. the epidemiological characteristics of hand foot and mouth disease (HFMD) in Shandong province in the past 2007~2011 years, the characteristics of the population and the characteristics of the time distribution were analyzed to provide scientific basis for the prevention and control of hand, foot and mouth.
2. the characteristics of the etiology of hand foot and mouth disease in Shandong province were analyzed.
3. the whole gene sequence database of the VP1 coding region of Shandong local strain 71 (enterovirus71, EV71) was set up to analyze the evolution characteristics of the local strain of EV71 in Shandong.
4. establish coxsackievirus A group 16 type (coxsackievirus A16, CoxA16) Shandong native strain VPl coding region full gene sequence database, analyze CoxA16 Shandong local plant gene evolution characteristics.
5. analysis of the clinical characteristics and death risk factors of the death cases of hand foot and mouth disease.
[research methods]
1. descriptive study: according to disease reporting information and control information system of hand foot and mouth disease prevention China, statistical analysis of 2007-2011 years of Shandong province and the incidence rate of HFMD, age composition, sex ratio, pathogen proportion and other descriptive indicators, using epidemiological principle in Shandong province HFMD three distribution according to the case. Foot and mouth disease survey, a descriptive analysis of the clinical features of hand foot and mouth disease deaths.
2. etiology characteristics: random sampling of stools, throat swabs, hand foot and mouth disease specimens, virus isolation, nucleic acid extraction, RT-PCR sequencing and other steps were carried out to analyze the gene evolution characteristics of EV71 and CoxA16 of HFMD pathogens in Shandong province in 2007~2011 years.
3. death risk factors of HFMD deaths: the case group of severe cases as control group, using 1:3 matched case-control study of HFMD death risk factors. Studies using conditional Logistic regression analysis on the variables, using SAS9.1 software for statistical analysis.
[results]
From 1.2007 to 2011, the total incidence of hand foot mouth disease in Shandong province was 38267 cases, 32434 cases, 138227 cases, 141744 cases, 95796 cases, the cumulative incidence rate was 4.09/ ten thousand, 3.46/ 10000, 14.76/ 10000, 15.13/ Vanward 10.01/ ten thousand.
Shandong Province in 2. ~ 2011 foot and mouth.2007 disease in children under the age of 5, were under the age of 5 accounting for the proportion of the total number of cases were 88.57%, 91.28%, 91.89%, 91.21%, severe cases of 89.00%. are more concentrated in the 3 age groups of.2009 to 2011, under the age of 3, accounting for the proportion of severe cases of severe cases were 84.08%, 77.94%, 73.01%. HFMD cases in men than in women, 2007-2011 years of HFMD cases sex ratio fluctuated between 1.66-1.80; 5-8 month is the high incidence of HFMD, 2007-2011 years, each year 5-8 month HFMD incidence accounted for the proportion of the total number of patients were 81.38%, 77.73%, 64.10%, 74.72%, 73.60%.
3.EV71 and CoxA16 are the main pathogens of.2008 in Shandong province to cause HFMD outbreak in 2011 of each year by EV71 the number of HFMD cases accounted for the proportion of the total number of cases were 60.53%, 67.02%, 34.69%, 50.57%; 2008~2011 years of CoxA16 each year due to the number of HFMD cases accounted for the proportion of the total number of cases respectively. 27.63%, 3.64%, 37.08%, 29.78%.
From 4.2007 to 2011, 67 strains of EV71 isolates from Shandong were EV71C4a subtype.2011 EV71 isolates from Shandong and nucleotide CoxA16 prototype strain homology between 62.1%-63.4%, EV71 and the nucleotide homology between prototype strains ranged from 80.5% to 82.9%, and EV71B represents the nucleotide homology between 83% ~ 85.4%, and EV71C1 nucleotide homology between 85.6%-88.5% and EV71C2, represent the nucleotide homology between 87.4% ~ 90.3%, and EV71C3 represents the nucleotide homology between 86.7% ~ 88.7%, and EV71C4a represents the nucleotide homology between 93.3% ~ 96.6%, and EV71C4b represents the nucleotide homology between 90.1% ~ 93.1%.
From 5.2007 to 2011, 38 strains of CoxA16 isolates from Shandong belong to B1 subtype.2011 CoxA16 isolates from Shandong and nucleotide CoxA16 prototype strain homology between 75.1% ~ 77.3%, and the nucleotide homology between B2 prototype strains ranged from 89% to 90%, and in 2007 7 strains of isolates from Shandong between the nucleotide homology was 90.9%-95.3%.
6. death cases of total average time duration of 82.40 - 5.39 hours, heating the highest temperature average value is 39.08 + 0.15. C (OR=16.16, P=0.0398), cough (OR=189.50, P=0.0072) neck resistance, vomiting (OR=16.16, P=0.0398) were risk factors of death in severe cases with hand foot mouth disease, increased age (OR=8.04, P=0.0131) is the protection factors of death cases.
[conclusions and recommendations]
1. the incidence of hand foot and mouth disease (HFMD) in Shandong province is high, the incidence of severe disease is high and the harm is serious, and prevention and control should be strengthened.
Children under 2.5 years old are high incidence of hand foot mouth disease. Among them, children under 3 years old are high-risk groups of severe hand, foot and mouth disease and death. We should strengthen clinical monitoring for children under 3 years of age, and prevent and cure children's severe or death.
From 3.5 to August is a period of high incidence of HFMD, health departments should strengthen the health education for children and adolescents at the time, good kindergartens, primary school children gathered in the disinfection, to prevent HFMD outbreaks.
4.EV71 is the most dominant pathogen of hand foot and mouth disease in Shandong Province, and EV71 infection is a risk factor for severe occurrence.
5.EV71 and CoxA16 are in the process of continuous gene mutation, and the speed of virus mutation is fast. We should strengthen the monitoring of the prevalence of EV71 and CoxA16, prevent the emergence of new strains and cause epidemic.
6., cough, neck resistance and vomiting are risk factors for the death of hand, foot and mouth disease. Age increase is a protective factor for death. We should strengthen the clinical care of children with severe HFMD, who have cough, neck resistance and vomiting symptoms, so as to prevent death.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R725.1

【參考文獻】

相關(guān)期刊論文 前10條

1 馬金海;劉靜;陸彪;;手足口病的診斷與治療現(xiàn)狀[J];中國兒童保健雜志;2009年04期

2 陳豪敏;康鍇;王海峰;王彥霞;蘇佳;;2009年河南省手足口病疫情分析與2010年疫情趨勢預(yù)測和預(yù)防控制工作策略[J];河南預(yù)防醫(yī)學(xué)雜志;2010年03期

3 茹維平;王彥霞;康鍇;王海峰;尤愛國;;危重型手足口病臨床癥狀及預(yù)警因素分析[J];鄭州大學(xué)學(xué)報(醫(yī)學(xué)版);2011年04期

4 ;2010年12月中國甲乙丙類傳染病疫情動態(tài)簡介[J];疾病監(jiān)測;2011年01期

5 董曉楠;應(yīng)劍;陳應(yīng)華;;1970～2004年全球腸道病毒71型分離株的分子流行病學(xué)分析[J];科學(xué)通報;2007年09期

6 曹志冬;曾大軍;王全意;鄭曉龍;王飛躍;;2008年北京市手足口病流行的規(guī)律與傳播機制[J];科學(xué)通報;2010年09期

7 夏亨海,楊恭義;手足口病27例臨床觀察[J];山東醫(yī)藥;1984年11期

8 王連森;畢振強;房玉英;王顯軍;;2008年山東省手足口病流行病學(xué)分析[J];山東醫(yī)藥;2009年19期

9 孫大鵬;王顯軍;方立群;姜寶法;曹務(wù)春;;2009年臨沂市手足口病流行特征及重癥病例危險因素分析[J];中國病原生物學(xué)雜志;2011年02期

10 ;2008年手足口病預(yù)防控制指南[J];中華實驗和臨床感染病雜志(電子版);2008年03期

，

本文編號：1735767